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Background

Intracavitary brachytherapy is used along with external beam radiotherapy for the treatment of gynecologic malignancies including cervical and endometrial cancer.

The placement of a vaginal cylinder, which is performed on up to 5 separate occasions, can be uncomfortable causing the patient pain. This discomfort can lead to movement and displacement of the cylinder, possibly causing over- or under-treatment of part of the target volume.

Muscle relaxation videos (MRV) teach a technique that interrupts the sympathetic "fight or flight" response and activates a relaxation response. They teach tensing and releasing selected muscle groups that provides a relaxed state of the body.

Materials/Methods

Patients were randomized in a 1:1 fashion to MRV in addition to standard of care management (SOCM) versus SOCM alone.

All patients were put on bedrest for 48 to 72 hours, including an indwelling foley catheter, vaginal packing and medication to induce constipation.

MRV was given as 5 videos selected by a certified music therapist incorporating guidelines for relaxing music including attention to harmonic consonance and tempo. The videos had visual scenes with peaceful images.

After the placement of the cylinder on day 1, 30 minutes of MRV four times (total 120 minutes) over the immediate post-surgical 44 hours.

On day 2, patients watched the video at 9:00, 13:00, and 17:00

On day 3, patients watched the video at 9:00

MRV+SOCM and SOCM data were gathered before and after the times noted above.

Pain was assessed using a Visual Rating Scale (VRS).

Patient controlled analgesia (PCA) medication utilization was recorded and converted to standardized units.

State Trait Anxiety Inventory (STAI) was used to assess anxiety.

Differences in pain and anxiety were tested using analysis of variance (repeated measures) and opioid consumption was compared using a t test.

Results

60 patients, all with cervical cancer, were enrolled (31 to MRV, 29 to SOCM).

Perceived pain was significantly reduced between cohorts by VRS (p=0.027)

Opiod consumption was not different in the 2 arms (p=0.432).

Anxiety was significantly reduced when MRV was used with brachytherapy (p=0.001).

Author's Conclusions

MRVs, combined with SOCM, reduce anxiety and pain but do not affect opiod consumption compared with SOCM alone.

MRVs are a feasible method to reduce pain and anxiety in patients receiving brachytherapy.

Clinical Implications

MRVs are a low-cost, feasible method to reduce anxiety and pain during brachytherapy, although they do not affect opiod consumption.

MRVs, if used, should be chosen by a certified music therapist and the videos should be carefully selected to match what was utilized in this study.

Further randomized controlled studies could be performed to study the use of MRV in other radiotherapy procedures, including standard external beam radiotherapy. Any reduction of pain or anxiety could decrease intrafraction motion and improve even further upon the accuracy of radiation.